Medical device, method and system thereof

ABSTRACT

Embodiments of the invention are directed towards a medical device, method and system thereof for the placement or passage of patches, sutures, anchors, tags, tissue sensors and more particularly to a medical device for repairing female pelvic organ or tissue prolapsed region. The device may be used for the placement of stereotactic markers into tissue near joints or tumors for guidance during orthopedic or neurosurgical procedures.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a national stage application under 35 U.S.C. 371 ofPCT Application No. PCT/US2013/029197 having an international filingdate of 5 Mar. 2013, which designated the United States, which PCTapplication claimed the benefit of U.S. Provisional Application No.61/607,411 filed 6 Mar. 2012, the entire disclosure of each of theforegoing are incorporated herein by reference in their entities.

BACKGROUND OF THE INVENTION

Field of the Invention

The invention generally relates to a medical device, method and systemthereof for the placement or passage of patches, sutures, anchors, tags,tissue sensors and more particularly to a medical device for repairingfemale pelvic organ or tissue prolapsed region.

Discussion of the Related Art

It is estimated that nearly twelve percent of women will need surgeryfor pelvic organ prolapse. Historically, the long term result of thesesurgeries using the patient's own tissue for the repair, has beendisappointing for both the patients and the surgeons. Recurrence ofprolapse after standard autologous tissue repairs has been reported tobe as high as about thirty percent to about forty percent.

Many current methods for pelvic reconstruction use instruments designedfor laparoscopic surgery. These devices allow the surgeon to suture oranchor tissue, or to staple a patch or graft material into place. Whilelaparoscopic instruments may be effective for laparoscopy when usedunder direct visualization, they tend to be less effective when usedused in conditions of limited space and visualization, e.g., the vagina.More specifically, when laparoscopic instruments are used for vaginalsurgery, there is a lack of tactile assistance or feedback when workingfrom the end of an instrument. In addition, laparoscopic instruments arerigid and therefore not suited to the angles and planes encountered invaginal surgery.

Methods, techniques and devices were developed that use a perinealapproach. In these techniques, needles or carriers are placed throughthe skin of the perineum (outside the vagina) and into the pelvis andvagina. Once in position, graft material is attached to the needleswhich are drawn brought back out to the external skin, pulling the graftinto position.

Moreover, these related art instruments are difficult to use with aperineal approach. Moreover, as the perineal approach is not widelytaught, or familiar to many surgeons it is not a general skill of mostsurgeons, and it requires passage of a needle/carrier blindly through agreat distance of tissue. Therefore, the difficulty of these techniquesand related art devices limit their use to a very few specialists whoare able to perform them, thereby limiting the availability of thetreatment. Furthermore, this percutaneous approach has resulted inadditional possible surgical complications, including infections,surrounding organ injuries, and painful scarring.

Other currently available methods and instruments available use a moretraditional and familiar vaginal approach. These are generally sold as akit, which include rigid devices used to aid in the attachment of graftmaterials. The graft is preformed and specific to the repair being done,i.e., anterior, posterior or apical. Currently available methods andinstruments for the vaginal approach to prolapse repair utilize surgicalskills and anatomical landmarks familiar to most gynecologists. However,the cost associated with the kits, the generally rigid and unwieldynature of these devices render these kits problematic.

Therefore, there is a need for a device, method and/or system thataddresses the above and other problems.

SUMMARY OF THE INVENTION

Accordingly, the invention is directed to a medical device, method andsystem thereof that substantially obviates one or more of the problemsdue to limitations and disadvantages of the related art.

An advantage of the invention is to provide a flexible finger-tipmedical device for treatment that is configured to provide tactilefeedback.

Another advantage of the invention is to provide a modular medicaldevice that provides one robust tool allowing for different modularheads, e.g., visualization head, suture head, staple head, tag head, andcombinations thereof.

Yet another advantage of the invention is to provide a device where auser not under visual would be able to locate the operating end based onorientation with one or more fingers.

Still yet another advantage of the invention is a medical device havingstability of the and alignability along an axis of one or more offinger, hand, and arm, thereby allowing a using to accurately orient theoperable end without the need of direct visualization.

Yet still another advantage of the invention is to provide a direct wayto secure sutures and anchors in the vaginal approach to female pelvicorgan prolapse repair.

Another advantage of the invention is its simplicity when used with abutton or latch mechanism to deploy the anchor or tag.

Yet still another advantage of the invention is to provide a medicaldevice with tactile feedback.

Another advantage of the invention is providing a flexible wire,flexible shaft, or other flexible mechanism allowing it to be usedthrough small incisions and placed anywhere the fingertip can reach, notlimited by a rigid or thick shaft.

Additional features and advantages of the invention will be set forth inthe description which follows, and in part will be apparent from thedescription, or may be learned by practice of embodiments of theinvention. The objectives and other advantages of the invention will berealized and attained by the structure particularly pointed out in thewritten description and claims hereof as well as the appended drawings.

One embodiment is directed towards a device having a two finger sheathand having at least one open finger, thereby allowing the user to havetactile dexterity to effectively map the surgical area by finger tip.The two finger sheath provides stability of the device and alignabilityof the device along an axis of the hand or arm. Other embodimentsinclude at least one closed end finger sheath to allow the user toeffectively and precisely secure an anchor to the patient. In otherembodiments, the sheath may be configured to only one finger, twofingers or three fingers. Still other embodiments include releasableattached devices to the sheaths which can assist the user in placingsutures.

In other embodiments, the device includes a kit, which contains at leasttwo finger sheaths, a shaft or cable, a cylinder, a tapered ridge, andanchors and/or sutures.

In still another embodiment, the device is configured to allow a user toascertain the force of placement of an anchor, suture, tag or othermechanism. In yet another embodiment, a viewing instrument may beattached to the device to provide active visualization.

Yet still another embodiment is directed towards a tubular member havinga lumen extending from a proximal end to a distal end, a finger assemblyreleasably coupled to a distal portion of the tubular member, anoperating unit, directions for use and one or more of sutures, anchors,and the like. The finger assembly includes a first finger slot andsecond finger slot.

Still another embodiment is directed towards a method for using thedevice. The method allows the user to map the surgical region using atleast one exposed finger. The user can then use the device to placeanchors by way of an incision, e.g., a vaginal incision. In oneembodiment, the anchors can be placed into ligaments located in thepelvis. The user may repair the pelvic organ prolapse or weakenedvaginal tissues using a graft and anchors and/or sutures, or may do therepair using only anchors and/or sutures and the patient's own tissues.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory and areintended to provide further explanation of the invention as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are included to provide a furtherunderstanding of the invention and are incorporated in and constitute apart of this specification, illustrate embodiments of the invention andtogether with the description serve to explain the principles of theinvention.

In the drawings:

FIG. 1 illustrates a flow diagram highlighting aspects of a methodaccording to an embodiment of the invention;

FIG. 2 illustrates a perspective view of an endoscopic suture deviceaccording to an embodiment of the invention;

FIG. 3 illustrates a perspective view of a needle catch mechanism with aneedle and a phantom view of a cannula body according to anotherembodiment of the invention;

FIG. 4 illustrates a cross-section view of a stitching device in an opencondition according to another embodiment of the invention;

FIG. 5 illustrates a cross-section view of the stitching device of FIG.4 in a closed condition;

FIG. 6 illustrates a bottom of the stitching device of FIG. 4;

FIG. 7A illustrates a top view of a device according to anotherembodiment of the invention;

FIG. 7B illustrates a side view of the device in FIG. 7A;

FIG. 8 illustrates a top view of a device according to anotherembodiment of the invention;

FIG. 9 illustrates a magnified view of a cylinder portion of the devicein FIG. 7A or FIG. 8;

FIG. 10 illustrates a detailed view of the cylinder portion in FIG. 9without an anchor;

FIG. 11A illustrates a cross-sectional detailed view of the cylinderportion of FIG. 7A with an anchor;

FIG. 11B illustrates a perspective view of a device according to anembodiment of the invention;

FIG. 12 illustrates an end view of FIG. 7A without a unit attached;

FIG. 13 illustrates a magnified view of a distal portion of the devicein FIG. 7A or 8;

FIG. 14 illustrates a magnified view of a distal portion of the devicein FIG. 13;

FIG. 15 illustrates a magnified view of a distal portion of the devicein FIG. 7A or FIG. 8;

FIG. 16 illustrates a bottom view of a unit according to anotherembodiment of the invention;

FIG. 17 illustrates a side-view of the device in FIG. 16;

FIG. 18 illustrates a detailed view of a unit according to anotherembodiment;

FIG. 19 illustrates a detailed view of FIG. 18 with an anchor;

FIG. 20 illustrates an anchor according to another embodiment of theinvention view;

FIG. 21 illustrates an anchor of FIG. 20 in a second configuration; and

FIG. 22 illustrates an anchor of FIG. 21 in a third configuration.

DETAILED DESCRIPTION OF THE ILLUSTRATED EMBODIMENTS

An embodiment of the invention is directed towards a medical device thatcan be used in areas of limited space and limited or novisualizabilitability, e.g., transvaginal pelvic surgery, repair ofpelvic organ prolapse. In one embodiment, the medical device isconfigured for placement or passage of medical patches, sutures,stitches, tags including RFID tags, stereotactic tags, anchors, locatingdevices, sensors including chemical sensors, temperature sensors, andpressure sensors. The sensors may communicate wirelessly with externaldevices over a network. In one embodiment, the sensors use Bluetoothprotocol for communication.

In one embodiment, the medical device is a configured to be used withone or more fingers, e.g., a finger-tip device, to place sutures,stitches, anchors, or tags, thereby allowing safe placement into anyareas of the body that are difficult to reach or see. The device may beused for the placement of stereotactic markers into tissue near jointsor tumors for guidance during orthopedic or neurosurgical procedures.

One embodiment includes a method and system for placement of sutures,stitches, anchors, sensors, or tags from a finger-tip device, allowingsafe placement into any areas of the body that are difficult to reach orsee. In one embodiment, the device includes a flexible tubular memberhaving a lumen extending from a proximal end to a distal end. Anactuator is configured to fit within a portion of the lumen and a fingersheath is coupled to a distal portion of a tubular member. An operatingunit is releasably coupled to a distal end of the tubular member. Theoperating unit is configured to operate with movement of the actuatorfrom a first position to a second position. The operating unit isconfigured for placement of medical patches, sutures, anchors, locatingdevices, and sensors.

In one embodiment, the assembly includes a sheath unit configured toreceive at least one finger. In a preferred embodiment, the sheath unitis configured to receive at least two fingers. The sheath unit isconfigured to receive an operating unit and the operating unit isconfigured for placement or passage of medical patches, sutures,stitches, tags including RFID tags, stereotactic tags, anchors, locatingdevices, sensors including chemical sensors, temperature sensors, andpressure sensors.

In one embodiment, similar to neurosurgical stereotactic markerplacement, placement of thermal sensors for cryotherapy and hyperthermiatreatments, tissue sensors for biochemical markers like glucose, nitricoxide and oxygen that would be useful in diabetes, critical care andorgan transplant management may be done.

One embodiment is directed towards a medical apparatus. The medicalapparatus includes a tubular member having a lumen extending from aproximal end to a distal end, a finger assembly releasably coupled to adistal portion of the tubular member and an operating unit coupled to adistal end of the tubular member. The finger assembly includes a firstfinger slot and second finger slot.

Another embodiment is directed towards a medical device repairing ananatomical region with a device. The device includes a tubular memberhaving a lumen extending from a proximal end to a distal end, a fingersheath unit coupled to a distal portion of the tubular member, an anchorunit releasably coupled to end of the tubular member configured todeliver an anchor and a flexible member coupled to the anchor unit. Thefinger sheath unit includes a first finger sheath and a second fingersheath arranged substantially in a similar plane. The flexible memberincludes a lumen extending from a proximal end to a distal end and isconfigured to receive an actuator. The actuator is configured to fitwithin a portion of the lumen of the flexible member and actuate theanchor unit upon movement of the actuator from a first location tosecond location.

One embodiment is directed towards a medical device for repairing femalepelvic organ or tissue prolapsed region. The device includes a tubularmember having a lumen extending from a proximal end to a distal end, afinger assembly releasably coupled to a distal portion of the tubularmember, an operational unit releasably coupled to a distal region of thetubular member, and a flexible member coupled to the operational unit.The flexible member includes a lumen extending from a proximal end to adistal end and configured to receive an actuator. The operational unitis configured to deliver one of a suture or anchor to repair theprolapsed region upon actuation of the actuator. At least a portion ofthe actuator is configured to fit within a portion of the lumen of theflexible member and actuate the operational unit upon movement of theactuator from a first location to second location. The distal end of theflexible member is configured to extend outside a patient while themedical device is in use. The finger assembly includes a first openended finger sheath and a second closed ended finger sheath arranged ina substantially similar plane.

One embodiment is directed to a method of repairing an anatomical regionwith an apparatus. The method includes creating an incision, developingaccess from the incision to the anatomical region, mapping of theanatomical region, inserting the device through the incision to theanatomical region and activating the device to deliver one of an anchor,suture, sensor, marker, and tag into the anatomical region.

Another embodiment is directed towards a method of repairing a prolapsedorgan. The method includes creating an incision in an anterior vaginalmucosa, dissecting the mucosa from an underlying connective tissue,mapping a pelvic region of a patient, inserting a device through thevaginal incision into the pelvic region of the patient, and inserting atleast one of an anchor and a suture into the pelvic region of thepatient by actuating the device.

In embodiments, the mapping may be conducted with a visualizationinstrument or through tactile feedback with or without the device. Inpreferred embodiment, the mapping is conducted with the device.

In one embodiment, the operating unit and sheath are configured to bereleasably attached to each other. For example, a male and femaleconnector may be used, tongue and groove connection, snap and grooveconnection, combinations of the same and the like. In a preferredembodiment, a connection mechanism is formed on the operating andincludes a tapered ridge. The finger sheath includes a groove andreceiver configured to be releasably coupled to the tapered ridge of theconnection mechanism. It is noted that the connection mechanism may beconfigured on the finger sheath the groove and receiver may beconfigured on the operating unit and vice versa. Also, the finger sheathand operating unit may be one integral unit.

For example, the operating unit is described herein or may include anoperating unit as described with reference to U.S. Pat. Nos. 4,726,371;4,892,520; 5,079,629; 5,478,344; 5,538,506; 5,925,064; 6,048,351;6,332,888; 6,475,135; 7,338,502 and U.S. Patent Application PublicationNos. 2004/0231167; 2008/0167680; 2010/0217282; 2011/0092985; and2011/0092991, each of which are incorporated herein by reference intheir entirety. The operating unit may be coupled to a flexible shaft orcable. The operating unit may be operated with a push button at the endof a flexible cable or alternatively operated with a thumb at the sameend of the operating unit. The device is configured to allow a user totraverse a tortuous anatomy and also configured to have a mechanism tooperate the operating unit at the same end as the operating unit or anend opposite to the operating unit and external to the patient.

In one embodiment, an exemplary use for the device is for the repair offemale pelvic organ prolapse. A vaginal approach is preferred, but isdifficult because of limited space and visualization. In this situation,and other surgical circumstances, the anatomical locations are easilyaccessible to fingertips, but less accessible using currently availableunwieldy and rigid instruments. The device of this invention may allowaccess for the surgeons' fingers to be used to place a suture, anchor,tag, or sensor directly into the desired position by way of the vaginalapproach and through small incisions and would allow the surgeon to mapthe surgical area. The instrument would allow precise placement ofsuture and/or anchors, which, may be used with autologous tissues orgraft materials.

Biocompatible surgical mesh and medical patches may be attached tovarious portions of a body with the device, e.g., with anchors, sutures,staples out an operating unit of the device. In one embodiment, thebiocompatible surgical mesh and patch materials may include patches andmay be made from materials including but not limited to polymers,thermoplastics, and PTFE and biological materials. In addition, thematerials may be bioabaorbable, resorbable, or permanent. Bioabsorbablematerials include bioabsorbable polymers and copolymers composed fromvarying amounts of one or more of the following monomer examples,glycolide, d,1-lactide, 1-lactide, d-lactide, p-dioxanone(1,4-dioxane-2-one), trimethylene carbonate (1,3-dioxane-2-one),ε-caprolactone, γ-butyrolactone, δ-valerolactone, 1,4-dioxepan-2-one,and 1,5-dioxepan-2-one. These meshes may have any geometric shape and/orreinforced matrix. Specific examples of surgical mesh and medicalpatches that may be used include, but are not limited to, EthiconPhysiomesh™; Ethicon Proceed™; Ethicon Prolene™; Ethicon Vicryl™;Ethicon Ultrapro; Ethicon FlexHD™; Ethicon Mersilene™; Ethicon GynecareGynemesh™; Boston Scientific Repliform®; Boston Scientific Xenoform®;Boston Scientific Polyform®; Bard Ventrio™; Bard Avaulta®; BardPelvitex®; Bard Pelvicol®; Bard Pelvisoft®; American Medical System(AMS) InteXen™; AMS Apogee™; AMS Perigee™; AMS Elevate®; Gore Gore-Tex®;Cook Biotech SymphaSIS™; and SurgiSIS®.

The sutures, anchors, staples and other attachment mechanisms used withthe device, that is, the operating unit of the device may be made frommaterials including, but not limited to, thermoplastic, polymers,polypropylene, monocryl, polyglactin, polytetrafluoroethylene (PTFE),nylon and other biocompatible materials. Examples of sutures that may beused include, but are not limited to, Ethicon Prolene™; EthiconMonocryl™; Ethicon Vicryl; Ethicon PDS; Ethicon Pronova™; EthiconEthibond; Ethicon Ethilon; and Covidien Dexon™. In addition, thematerials may be bioabaorbable, resorbable, or permanent. Bioabsorbablematerials include bioabsorbable polymers and copolymers composed fromvarying amounts of one or more of the following monomer examples,glycolide, d,1-lactide, 1-lactide, d-lactide, p-dioxanone(1,4-dioxane-2-one), trimethylene carbonate (1,3-dioxane-2-one),ε-caprolactone, γ-butyrolactone, δ-valerolactone, 1,4-dioxepan-2-one,and 1,5-dioxepan-2-one.

Moreover, the mesh, patch, sutures, anchors, staples and/or otherattachment and implantable components may include an imaging material,e.g., echogenic material, radio opaque material, and the like. The radioopaque compounds may include ionic and non-ionic compounds. Morespecifically, radiographic materials as described with reference to U.S.Pat. No. 5,746,998 and U.S. Pat. No. 7,790,141 may used in theconstruction of the mesh, patch, sutures, anchors, staples and/or otherattachment and implantable components.

In addition, the mesh, patch, sutures, anchors, staples and/or otherattachment and implantable components may include radio frequencyidentification system, and more particularly RFID transponder as knownin the art.

Various components of the device may be constructed from variousmaterials as known in the art. For example, the tubular member,catheter, cable, rod, finger sheath and/or operating unit may beconstructed from materials, such as polyesters, polyurethanes,polyamides, polyolefins including polyethylene and polypropylene, andany copolymers thereof. Some more specific examples of suitablematerials include, but are not limited to: nylon; polyester elastomer;polyether/block polyamide, such as PEBAX, Hytrel, and/or Arnitel;polyamid such as Grilamid; flouro-polymer such as Kynar; polyether etherketone (PEEK); polyethylene (PE); polyurethane; polyolefin copolymer(POC); and tetrafluoroethylenes such as polytetrafluoroethylene (PTFE).

Reference will now be made in detail to an embodiment of the presentinvention, example of which is illustrated in the accompanying drawings.

FIG. 1 illustrates a flow diagram highlighting aspects of a methodaccording to an embodiment of the invention.

Referring to FIG. 1, the method is generally depicted as reference 100.The method includes creating an incision 102 at a desired situs, e.g.,anterior vaginal mucosa, posterior vaginal mucosa, or vaginal apex. Itis noted that the device and method may be used at other locations andfor other uses. For example, the device may be used for setting markersor tags in orthopedic and neurosurgical procedures where navigationsystems are used to guide placement of implants and the like. The mucosais dissected 104 sharply and/or bluntly away from the underlyingconnective tissue plane (endopelvic fascia). Deficiency or breakdown ofthis connective tissue layer is what allows the prolapse and bulging ofthe vaginal walls and underlying pelvic organs into the vagina to occur,i.e., the bladder from anteriorly (cystocele), the rectum fromposteriorly (rectocele), the uterus or intestines from superiorly(uterine prolapse or enterocele), on the vaginal walls from laterally(paravaginal defect).

The connective tissue plane can be traced to the pelvic side wall wheresubstantial ligamentous and fascial structures exist and serve aslandmarks and anchor points 106. The mapping may be done while thedevice is being used by the user, e.g., with one or more finger tips.After a map of the surgical area is developed, the device on two or morefinger(s) is inserted the device into the vagina 107. The device isarranged on a co-axial orientation to an axis of the arm and/or hand toaid in orientation. Anchors and sutures are generally set into thesacrospinous ligament, arcus tendentious, obturator fascia and coopersligament 108. Following this plane through a small vaginal incision tothe pelvic sidewall is a basic gynecologic surgical maneuver. Once thisplane is developed for the patient, the anatomical landmarks are easilypalpable and the sacrospinous ligament, arcus tendineous, Cooper'sligament and obturator fascia are easily identified though verydifficult to visualize.

The device may be used with surgeons' second and third fingers to aid inlocation and placement to a desired location on the pelvic wall andthese fingers provide tactile feedback via an exposed fingertip.Moreover, as the sheath utilizes at least two fingers the orientationthe stability of the device is readily maintained, e.g., middle fingerand the ring finger; index finger and middle finger; or little fingerand the ring finger. In this preferred embodiment, the user aligns thedevices via their fingers, hand, and/or arm to ensure proper placementwithout sight. The device is not offset from fingers, hand, and/or arm,e.g., along a central axis, thereby allowing alignment even though thereis no visualization.

Next, an anchor, with attached suture, is delivered from the deviceexactly to the desired location by pushing the button at the oppositeend of the device. In a preferred embodiment, this is done while thesurgeon is still in contact with the pelvic wall. With the anchorexposed, and pressure delivered 110 at the closed finger-tip end, thedevice will set the anchor into the tissue at the desired location inthe pelvic wall. In a preferred embodiment, the anchor and mesh areconfigured to repair, secure, or reattach the underlying connectivetissue, or anchor graft material that substantially supports theprolapsed organs.

Optionally, sutures may be attached to these anchors and can be used tosupport the vaginal wall itself, with or without the use of a graft.With the safety of vaginal mesh under scrutiny by the FDA, many surgeonsare returning to use mesh-free repairs. The device described hereinwould make those procedures much easier.

Alternatively, anchors and sutures in the sacrospinous ligament, arcustendentious, obturator fascia and/or coopers ligament could also be usedto suture graft material over the deficient connective tissue plane fora graft augmented repair. Alternatively, anchors without sutures may beused to directly tack graft material to the desired location.

In still other embodiments, the operating unit of the device may bemodified with devices known in the art. For example, the operating unitmay include a scope to give active visual aid to the surgeon. In anotherexample, the operating unit of device may include a endoscopic suturedevice or anchor device configured to secure the graph or support anprolapsed area. By way of example, the endoscopic suture systems may beincorporated in the operating unit and include systems as known in theart, e.g., as disclosed in U.S. Pat. Nos. 5,364,408; 5,458,609;5,478,344; 5,540,704; 5,575,800; 5,578,044; 5,662,664; 5,700,272;5,713,910; 5,741,277; 5,741,279; 6,048,351; 7,582,096, and U.S. PatentApplication Publication Nos. 2010/0217282; 2011/0092985 and2011/0092991, all of which are herein incorporated by reference.

The suture device may be used in laparoscopic procedures. The suturedevice, and in particular the head of the device, may be used with thepresent invention by attaching the head of the suture device to thefinger sheaths of the present invention. In general, the suture deviceautomatically throws, catches and retrieves a suture through the head ofthe device. An example of a suture device is described in U.S. Pat. Nos.5,741,277 and 7,582,096, which are incorporated herein by reference.

FIG. 2 illustrates a perspective view of an endoscopic suture deviceaccording to an embodiment of the invention.

Referring to FIG. 2, an apparatus is generally depicted as referencenumber 200. The apparatus 200 includes a connection mechanism 202 fixedto an end portion of the tubular member 204. A finger sheath (notshown), described with reference to FIGS. 7A-15 is utilized with thisdevice 200 and configured to be coupled to the device 200 via theconnection mechanism 202 as described with reference to FIGS. 13-15.

The apparatus 200 includes the body 204 having a first half 206 and asecond half 207. A needle slot 208 is utilized to deploy a cannula 210out of the cannula body 204. The cannula 210 can be utilized with otherinstruments as known in the art. For example, the cannula 210 isutilized to deploy a needle and sutures (not shown). Alternatively,other secondary devices may be delivered through the cannula 210, e.g.,visualization devices.

FIG. 3 illustrates a perspective view of a needle catch mechanism with aneedle and a phantom view of a cannula body according to anotherembodiment of the invention

Referring to FIG. 3, the suture system is generally depicted asreference number 300. The suture system includes a first half 302 and asecond half 304 configured to form a body 306. The system 300 includes aconnection mechanism 305 fixed to an end portion of the tubular member306. A finger sheath (not shown), described with reference to FIGS.7A-15 is utilized with this device 300 and configured to be coupled tothe device 300 via the connection mechanism 305 as described withreference to FIGS. 13-15.

A surgical needle 308 includes a needle tip 310 and a needle body 312,and a suture 314. A retainer lever 316 is pivotally mounted on a shaft318 and is biased to a neutral position by a spring 320 or othersuitable mechanism. A needle guide track terminates in an exit opening322. A flexible needle driver guide track and the needle guide trackcombine to form a continuous pathway in which a flexible needle driverwith a needle driver tip is slidably disposed. The needle 308 isinserted through the exit opening 322. The needle 312 and the suture 314are inserted into the needle guide track until the needle tip 310 ispositioned adjacent to the exit opening 322. It may be seen that duringinsertion into the needle guide track, the needle 308 causes theretainer lever 316 to rotate pivotally on the shaft 318 to a retractedposition. In operation, an actuator (not shown) is operated to advancethe needle 308.

To retrieve the needle 308 and the suture 314 the cannula body 306 isplaced in the surgical field and maneuvered to guide the needle tip 310and needle shaft through an opening in a needle catch, which includesthe opening and a catch bottom. The flexible needle driver is advancedin the needle guide track, engaging and pivotally rotating the retainerlever 316 and pinching and capturing the needle body 312 between theretainer lever 316 and a catch bottom. The needle 308 and the suture 314may then be removed from the surgical field through the surgical trocaror other suitable instrument. To release the needle 308 from beingpinched by the retainer lever 316 and the catch bottom, the flexibleneedle driver is retracted, allowing the retainer lever 316 to return tothe neutral position, thus freeing the needle 308.

In still other embodiments, an apparatus such as a suture device may bemodified with aspects of the invention including a finger sheath andconnection mechanism to provide a device that allows for advantages ofthe invention. Examples of devices that may be modified are disclosed inU.S. Pat. Nos. 7,828,189; 7,828,798; and 7,789,878; and U.S. PublicationNos. 2010/0094083; 2010/0217282; 2010/0274265; 2011/0040308;2010/0147921; 2006/0036232; 2009/0248046; and 2009/0259233, and are eachincorporated by reference, in particular, the portions of thedisclosures describing the head of the endoscopic stitching device. Morespecifically, each of the foregoing may be modified and adapted for usewith a connection mechanism 305 fixed to an end portion of any of theforegoing devices. A finger sheath (not shown), described with referenceto FIGS. 7A-15 is utilized with this any of the foregoing modifieddevices and configured to be coupled to the device via the connectionmechanism 305 as described with reference to FIGS. 13-15.

FIG. 4 illustrates a cross-section view of a stitching device in an opencondition according to another embodiment of the invention. FIG. 5illustrates a cross-section view of the stitching device of FIG. 4 in aclosed condition. FIG. 6 illustrates a bottom of the stitching device ofFIG. 4.

Referring to FIGS. 4-6, a suture system 400 includes a needle 402coupled to a first end 404, the needle is configured to be received by asecond end 406. A recess is formed in the second end 406 to receive aportion of the needle 402. The first end 404 and second end 406 aremaintained in an open position by an actuating mechanism. The actuatingmechanism includes a first slot 408 in the first end 404, a second slot410 on the second end 406, and a pin 412 is in communication with thefirst slot 408 and second slot 410. The pin 412 is coupled to anactuator 414, e.g., cable, rod and the like, configured to move the pinfrom a first position to a second position as indicated by arrow 416,thereby moving the first end 404 and second end 406 from a closedposition to an open position and vice versa.

Referring to FIG. 5, the suture system 400 is in a closed position. Theclosed position is achieved by moving the actuator 414 from a firstposition to a second position as indicated by arrow 417 to open thedevice. When the device is closed, the needle 402 is moved into of therecess of the second end 406. If tissue were present between the firstand second end 404, 406, the needle 402 would penetrate through thetissue prior to the entrance into recess.

FIG. 6 shows a bottom view of the suture system 400. The bottom portionincludes a connection mechanism 419. A finger sheath (not shown),described with reference to FIGS. 7A-15 is utilized with this device 400and configured to be coupled to the device 400 via the connectionmechanism 419 as described with reference to FIGS. 13-15.

FIG. 7A illustrates a top view of a device according to anotherembodiment of the invention.

Referring to FIG. 7A, the assembly is generally depicted as referencenumber 700. The assembly 700 includes an actuator 702 configured toactuate the delivery of an anchor from a unit 704 at the opposite end ofthe device 700. The unit 704 is coupled to the flexible shaft 706 andboth are constructed from materials known in the art, e.g.,thermoplastic material. The shaft 706 may be any length, e.g., equal to,greater than or less than the length of a finger sheath unit 708. Ananchor (not shown) is delivered from the unit 704 at a distal end of theinstrument when the actuator 702 is actuated. Furthermore, the user mayinsert additional anchors into a portion of the shaft 706 during use byremoving the actuator 702, inserting an anchor and reinserting theactuator 702. In addition, additional anchors may be added to the unit704 during or before use, e.g., another unit 704 can be removed andrecoupled to the shaft 706 as a cartridge attachment or the unit 704 maybe refilled. The actuator 702 may be a plunger or other actuatormechanism 702 configured to deliver an anchor from the unit 704. Forexample, the actuator may be a cable, remote control, spring driven,hydraulic or other pressure driven mechanism, or combinations of thesame and the like.

The finger sheath unit 708 is removably coupled to the shaft 706 andincludes at least two finger slots 710 and 712 configured to receive atleast a portion of user's fingers. It is noted that finger slots 710 and712 may include a supplemental medical devices rather than a finger slotor in addition to a finger slot, e.g., a cutter, visualization aids,storage, laser ablation devices and the like, may be coupled to at leastone of the finger slots 710, 712 or as an additional feature adjacent toone of the finger slots 710, 712. A visualization aid may include radioopaque (RO) markers, camera with or without light, or othervisualizations aids as known in the art. The finger slots 710 and 712are oriented to be co-axial and/or in substantially the same plane withthe unit 704 and/or centered over the unit 704. The co-axial, same planeand/or centered orientation enables a user to align the unit 704 withoutthe need for visualization or with poor visualization. In oneembodiment, one of the at least two finger slots is not a finger slot,but rather a supplemental treatment device or visualization aid.Moreover, the two finger slots may include one finger slot, two fingerslots or three finger slots.

In use, the apparatus 700 is guided to the desired treatment situs witha user's fingers in the finger sheaths 710 and 712 to a treatment situs.In this embodiment, the finger sheath 712 is an open end finger sheathand the finger sheath 710 is a closed end finger sheath. The open end offinger sheath 712 allows for accurate tactile feedback with a user'sfinger. The closed end of the finger sheath 708 allows for additionalpressure and stability to be exerted on an anchor during insertion andwhen it is in place. It is noted that each of the finger shealths may beadjustable to receive a plurality of different finger sizes, e.g., thediameter of the finger sheath may be adjustable with a ratchet or othermechanism. Moreover, the finger sheath may be configured to cover only aquarter or less of an end portion of predetermined finger of apredetermined user.

It is also noted that the finger sheath 710 and finger sheath 712 may bearranged in different planes with respect to each other. That is, thefirst finger sheath 710 and second finger sheath 712 may be arranged atany angle from 0 to 360 degrees around the shaft 706. Moreover, thefinger sheaths may be arranged at an angle from the shaft, e.g., about 1degree to about 20 degrees or greater. The first finger sheath 710 mayhave a portion, e.g., the distal end, located proximally from the secondfinger sheath 712. In still other embodiments, three finger sheaths mayused. In this embodiment, the finger sheath 710 and finger sheath 712are arranged in substantially the same plane with respect to each other.

FIG. 7B illustrates a side view of the device in FIG. 7A.

Referring to FIG. 7B, the finger assembly unit 708 includes fingersheaths 710 and 712. The finger assembly unit 708 is coupled to theshaft 706 (as will be seen in FIGS. 13-14). The unit 704 is also coupledto the shaft 706 (as shown in FIG. 9). The unit 704 is configured todeliver an anchor to a treatment situs upon actuation of the actuator702.

In this preferred embodiment, the distal end of the unit 704 isterminated at about the same distance as the closed end of the fingersheath 710. This termination distance allows for leverage in placing asuture, anchor or other item, assists in increasing the effect of theforce exerted on the device 700, and permits precise location whenvisualization is not available or poor. Of course, the distal end of theunit 704 may be located at a distance proximal or distal to either ofthe finger sheaths 710, 712.

In another embodiment, the actuator 702 may be placed directly adjacentthe unit 704 and there is no tubular member 706 (not shown). Thiscompact configuration is actuated by a user with the same hand as in thefinger sheath 708 rather than a different hand.

FIG. 8 illustrates a top view of a device according to anotherembodiment of the invention.

Referring to FIG. 8, the apparatus 800 includes a unit 704 configured todeliver anchors coupled to a flexible cable 709. The flexible cable 709permits access to a tortuous anatomy. Moreover, a distal end portion ofthe cable 709 may include a flexible shaft.

FIG. 9 illustrates a magnified view of a cylinder portion of the devicein FIG. 7A of FIG. 8.

Referring to FIG. 9, the unit 704 is coupled to the shaft 706 or cable709. The unit 704 is configured to deliver anchors to a treatment situsand includes a window 910. The window 910 is configured as anoval-shaped opening or other geometric shape in the wall of the unit704. A suture (not shown) can be attached to the anchor (not shown) viathis opening 910. The suture can extend out the window 910. In thisembodiment, the unit 704—is coupled to the shaft 706 or cable 709—withthreads 902 that allow it to be securely coupled. The unit 704 may beconnected to the shaft 706 prior to connecting the finger assembly 708or following the attachment of the finger assembly 708.

Other connection mechanisms other than threads 902 may be used to couplethe unit 704 to the shaft 706 or cable 709, e.g., a pressure fitcoupler, adhesive, releasable engagement device and the like.Furthermore, the connection may be permanent or it may be temporary.

A connection mechanism 904 is fixed to, and extends past, the upper sideof the shaft 704. The connection mechanism 904 is configured to accept afinger assembly 708 (not shown) by sliding the assembly 708 intoposition via the tapered ridge 906. Another type of coupler may beutilized to attach the finger sheath 708 to the shaft 706, e.g., thefinger sheath 708 may be permanently attached to the shaft 706 byadhesive, chemical bonding, welding, or other technique. Moreover, thefinger assembly 708 and shaft 706 may be formed as a one-piece unit.

FIG. 10 illustrates a detailed view of the cylinder portion in FIG. 9without an anchor.

Referring to FIG. 10, the unit 704 includes cylinder threads 902 on aproximal portion of the unit 704. The unit 704 includes a lumen 912extending from a distal end 914 to a proximal end—917. Near a middleportion of the lumen 912 are two internal ribs, a first rib 916 and asecond rib 918. A base of an anchor (not shown) will be held in positionbetween the ribs 916, 918. The opening 910 is configured to allow for asuture (not shown) attached to the anchor to exit the cylinder. Varioustypes of anchors may be used with or without sutures could be used.

FIG. 11A illustrates a cross-sectional detailed view of the cylinderportion of FIG. 7A with an anchor. FIG. 11B illustrates a perspectiveview of the device in FIG. 11 with a finger assembly.

Referring to FIGS. 11A and 11B, the unit 704 includes an anchor 1102having a base portion 1104 and tip portion 1106. The tip portion 1106includes a barb type geometry configured to penetrate tissue and preventremoval. The anchor 1102 is held in position between the two internalribs 916, 918. In a preferred embodiment, the anchor tip portion 1106includes an arrow shaped barb. In use, the plunger or other actuator(not shown) contacts the base portion 1104 of the anchor 1102 andreleases the anchor 1102 from the internal ribs 916, 918. The anchor1102 passes down the lumen 912 and out a distal end 917 of the unit 704to be placed in the desired situs of the patient. In operation, a tack1106 exits a distal end of the unit 704 upon activation of the actuator.The tack 1106 could be used to secure graft material, other material toitself or other regions, and the tack can include radiopaque (RO)marker, RFID tag active or passive, sensor and other devices.

FIG. 12 illustrates an end view of FIG. 7A without a unit attached.

Referring to FIG. 12, an end portion of the finger sheath unit 708 isshown having a finger assembly 708 attached. The finger assembly 708includes a first finger sheath 710 and a second finger sheath 712.Optionally, the first finger sheath 710 includes a hole 711 at endportion of the finger sheath 710. The hole 711 can be sized to allow fortactile feedback to the user's finger. The hole 711 may be of anygeometric configuration, e.g., circular, oval, triangular, square, etc.In this configuration, the apparatus does not have a unit 704 attachedto the shaft 706 or cable 709. The shaft 706 employs a tapered ridge 904which slides into a groove 1202 on a receiver 1204 which is locatedbetween the finger sheaths 710, 712. The tapered ridge 904 of aconnection mechanism 906 may be permanently or temporarily attached tothe shaft 706. In some embodiments, the finger sheath 708 is permanentlyattached to the shaft 706.

Moreover, an additional receiver 1206 may be used on another side of thefinger sheath 710, 712. In this embodiment, an additional receiver 1206is coupled to an opposite side of the finger sheath unit 708. Theadditional receiver 1206 includes a T-shape opening 1208 configured toreceive a tapered ridge 904, but may be any suitable geometric shape.The receiver 1206 is configured to receive a tapered ridge 904 of aconnection mechanism 906. Furthermore, the receiver 1206 and opening1208 are configured to lock once the tapered ridge 904 is in place tosecure the finger sheath unit 708 to the shaft 706. As illustrated, thefinger sheath 712 is open for the finger-tip to be exposed and allowtactile sensation for guiding the device onto position. The other fingersheath 710 is closed to allow finger tip pressure to push the anchorinto the tissue. The additional receiver 1206 allows a user to switchthe orientation of the finger sheaths 712, 710, e.g., from right to leftorientation and vice versa. Moreover, any operating unit may be utilizedwith finger assembly including a suture unit, staple unit, visualizationunit and sensor unit as described herein.

FIG. 13 illustrates a magnified view of a distal portion of the devicein FIG. 7A or 8. FIG. 14 illustrates a magnified view of a distalportion of the device in FIG. 13. FIG. 15 illustrates a magnified viewof a distal portion of the device in FIG. 7A or FIG. 8.

Referring to FIGS. 13-15, these figures represent attaching theoperating unit 708 to a shaft 706. The finger sheath unit 708 includes afirst finger sheath 710, second finger sheath 712, and a receiver 1204including a tapered groove 1202. The groove 1202 and receiver 1204 areconfigured to be releasably coupled to the tapered ridge 904. The groove1202 includes a locking portion to lock with a portion the ridge 904(not shown). In operation the sheath unit 708 slides onto the ridge 904of the shaft 706 or cable 709 as shown sequentially in FIGS. 13-15.

FIG. 16 illustrates a bottom view of a unit according to anotherembodiment of the invention. FIG. 17 illustrates a side-view of thedevice in FIG. 16.

Referring to FIGS. 16-17, the device 1700 is configured to providesutures to predetermined situs. The device 1700 includes a proximal end1704, a distal end 1702, a tapered groove 1202, and a needle 1706. Thetapered groove 1202 is configured to be releasably coupled to a receiver(not shown) as described herein. Moreover, a finger assembly isconfigured to be releasably coupled to the device 1700. The device 1700is actuated with an actuator as described herein and known in the art. Afinger sheath (not shown) of the finger assembly, but described withreference to FIGS. 7A-16 is utilized with this device 1700 andconfigured to be coupled to the device as described with reference toFIGS. 13-15.

FIG. 18 illustrates a detailed view of a unit according to anotherembodiment. FIG. 19 illustrates a detailed view of FIG. 18 with ananchor. FIG. 20 illustrates an anchor according to another embodiment ofthe invention view. FIG. 21 illustrates an anchor of FIG. 20 in a secondconfiguration. FIG. 22 illustrates an anchor of FIG. 21 in a thirdconfiguration.

Referring to FIGS. 18-22, the actuator unit is generally depicted asreference number 1900. The unit 1900 includes threads 1902, a proximalend 1905, a distal end 1903 and a lumen 1912 extending from a proximalend 1905 to a distal end 1903. The lumen includes a first slot 1922,second slot 1924, a window 1910 and first internal ridge 1916 and secondinternal ridge 1918. An anchor 1926 is configured to slide with a firstslot 1922 and second slot 1924. The anchor may include a RFID tag,transponder and/or imaging material as described herein. In thisembodiment, the anchor is constructed from an elastic material.

The anchor 1926 is a compressed configuration within the first slot 1922and second slot 1924 as shown in FIG. 20. After the anchor is releasedfrom the slot it expands to a second expanded position a deployedconfiguration as shown in FIG. 21. FIG. 22 illustrates the anchor in astaple like configuration. This deployed configuration will aid in theattachment to tissue. The anchor 1926 also includes a sharp tip 1934 ofany geometry. In this embodiment, the anchor 1926 includes a sharp tip1934 at a first angle, a first cutting surface 1932, and a second anglecutting surface 1930. Of course, other anchors of other geometricconfigurations may be used. The anchor may be configured with aplurality of cutting surfaces with or without sutures. The anchors maybe made with material that when released returns to an expanded shape(FIG. 21). The anchors may be reinforced with an internal or externalstiffening element, e.g., metal rib, wire or the like.

The inventions and methods described herein can be viewed as a whole, oras a number of separate inventions that can be used independently ormixed and matched as desired. All inventions, steps, processes, devicesand methods described herein can be mixed and matched as desired. Allpreviously described features, functions, or inventions described hereinor by reference may be mixed and matched as desired.

Moreover, though the present disclosure has included description of oneor more embodiments and certain variations and modifications, othervariations and modifications are within the scope of the disclosure,e.g., as may be within the skill and knowledge of those in the art,after understanding the present disclosure. It is intended to obtainrights which include alternative embodiments to the extent permitted,including alternate, interchangeable and/or equivalent structures,functions, ranges or steps to those claimed, whether or not suchalternate, interchangeable and/or equivalent structures, functions,ranges or steps are disclosed herein, and without intending to publiclydedicate any patentable subject matter.

What is claimed is:
 1. A method of repairing an anatomical region withan apparatus, comprising the steps of: creating an incision; developingaccess from the incision to the anatomical region; mapping of theanatomical region; inserting the apparatus through the incision to theanatomical region, wherein the apparatus comprises: a flexible tubularmember comprising a proximal end, a distal end, and a lumen extendingfrom the proximal end to the distal end; a finger assembly releasablycoupled to a distal end portion of the tubular member along a centralaxis of the flexible tubular member, wherein the finger assemblyincludes a first finger slot and a second finger slot; and an operatingunit coupled to the distal end of the tubular member; and activating theapparatus to deliver one or more of an anchor, suture, sensor, marker,and tag into the anatomical region.
 2. The method of claim 1, whereinthe mapping of the anatomical region step comprises tactile mapping witha fingertip.
 3. The method of claim 1, wherein the mapping of theanatomical region step comprises visual mapping with an optical device.4. A method of repairing a prolapsed organ, comprising the steps of:creating an incision in a vaginal mucosa; dissecting the vaginal mucosafrom an underlying connective tissue; mapping a pelvic region of apatient; inserting a device through the incision into the pelvic regionof the patient, wherein the device comprises a flexible tubular memberhaving a proximal end, a distal end, and a lumen extending from theproximal end to the distal end; a finger assembly releasably coupled toa distal portion of the flexible tubular member, wherein the fingerassembly includes a first finger slot and a second finger slot; and anoperating unit coupled to the distal end of the flexible tubular member;and inserting at least one of an anchor and a suture into the pelvicregion of the patient by actuating the device.
 5. The method of claim 4,wherein the device further comprises a suturing device.
 6. The method ofclaim 4, wherein the inserting at least one of an anchor and a suturestep comprises attaching a tissue or a graft with the at least one ofthe anchor and the suture to a ligament, tendon or fascia, wherein saidligament, tendon or fascia is selected from the group consisting of asacrospinous ligament, arcus tendinous, obturator fascia, Cooper'sligament, endopelvic fascia, and combinations thereof.
 7. The method ofclaim 4, wherein the inserting at least one of an anchor and a suturestep attaches a graft to the patient.
 8. The method of claim 4, whereinthe inserting at least one of an anchor and a suture step repairs anautologous tissue.
 9. The method of claim 8, wherein the anchorcomprises a radio frequency identification (RFID) tag.
 10. A medicaldevice for repairing female pelvic organ or tissue prolapsed region, themedical device comprising: a flexible tubular member comprising aproximal end, a distal end, a lumen extending from the proximal end tothe distal end, and a connection mechanism having a tapered ridge on adistal portion of the flexible tubular member; a finger sheath unitcoupled to a distal portion of the flexible tubular member along acentral axis of the flexible tubular member with a receiver where thereceiver is configured to receive the tapered ridge of the connectionmechanism, wherein the finger sheath unit comprises a first fingersheath and a second finger sheath arranged substantially in a similarplane; an actuator unit comprising a connection mechanism, a proximalend, a distal end, and a lumen extending from the proximal end of theactuator unit to the distal end of the actuator unit, the actuator unitbeing releasably coupled to the distal end of the tubular member with atubular member connection mechanism, the actuator unit being configuredto deliver an anchor; and an actuator configured to fit within a portionof the lumen of the flexible tubular member and actuate the actuatorunit upon movement of the actuator from a first location to a secondlocation.
 11. The medical device of claim 10, further comprising: avisualization unit releasably coupled to the tubular member.
 12. Themedical device of claim 10, wherein the first finger sheath comprises afirst finger sheath proximal end, a first finger sheath distal end, anda first finger sheath lumen extending from the first finger sheathproximal end to the first finger sheath distal end, the first fingersheath proximal end being open and the first finger sheath distal endbeing open and the second finger sheath comprising comprises a secondfinger sheath proximal end, a second finger sheath distal end, and asecond finger sheath lumen extending from the second finger sheathproximal end to the second finger sheath distal end, the second fingersheath proximal end being open and the second finger sheath distal endbeing closed.
 13. The medical device of claim 10, wherein the anchorcomprises a bioabsorbable material.
 14. The medical device of claim 10,wherein the anchor is configured to be in a first position inside theactuator unit and a second position, different than the first position,when delivered to the pelvic region.
 15. A medical device for repairinga female pelvic organ or a tissue prolapsed region, comprising: atubular member having a proximal end, a distal end, a lumen extendingfrom the proximal end to the distal end; a finger assemblynon-releasably coupled to a distal portion of the tubular member,wherein the finger assembly comprises a first open ended finger sheathand a second closed ended finger sheath arranged in a substantiallysimilar plane; and an operational unit releasably coupled to a distalregion of the tubular member and arranged below the finger assembly,wherein the operational unit is configured to deliver one or more of asuture, anchor suture, tissue sensor, marker and tag.
 16. The medicaldevice of claim 15, further comprising a second operational unit. 17.The medical device of claim 16, wherein the second operational unitcomprises a visualization aid.
 18. The medical device of claim 15,wherein the anchor suture comprises a tack end.
 19. The medical deviceof claim 15, wherein the anchor suture comprises a first barbed end anda second barbed end.
 20. The medical device of claim 15, wherein thefinger assembly is arranged coaxially aligned with the tubular member.21. The medical device of claim 15, wherein the operational unit isreleasably coupled to the distal region of the tubular member with athread and screw type mechanism.
 22. The medical device of claim 15,wherein the finger assembly further comprises a third finger sheath.